Human Resources Policy and Legislation

Council refuses to register plastic surgeon after 8 years of free service

According to the head of Steve Biko Academic Hospital Cardiology Department Andrew Sarkin, neither public nor private sector patients benefit from the country's current two-tiered health system (File photo)
Written by Kerry Cullinan

For the past eight years, Kenyan Dr Michael Rebeiro has been treating South African patients for free while he specialised as a plastic surgeon at Wits University.

The Department of Health does not allow non-South African registrars (trainee specialists) to be paid while they specialise, despite the fact that they work in government hospitals and treat patients.

Michael Rebeiro qualified as a doctor at Makarere University in Uganda, the oldest medical school in east Africa.

Michael Rebeiro qualified as a doctor at Makarere University in Uganda, the oldest medical school in east Africa.

But now that Rebeiro has qualified as a plastic surgeon, the Health Professions Council of SA (HPCSA) does not want to register him unless he repeats his undergraduate degree, possibly also including a further two years’ unpaid community service at the level of a medical officer (ordinary doctor).

“This decision is not acceptable. I have been without a salary for eight years, all the time while treating patients and supervising junior doctors,” said a frustrated Rebeiro. “My wife, who is an architect, has been supporting me all this time. Both my sons have grown up in South Africa and we have been here for so long that we all have permanent residency, so we are locals in every respect.

“I have appealed to the HPCSA and haven’t heard anything except that I don’t qualify to be registered because I did my undergraduate degree elsewhere.”

The HPCSA’s decision has deeply angered Rebeiro’s wife, Jyotsna, who has been the family’s sole breadwinner for many years.

“Michael has spent almost a decade working for free, looking after the South African public and doing crazy shifts, while our family had to scrape by living on my salary,” she told Health-e News.

“If Michael’s undergraduate qualifications are not recognised, then how was he allowed to work in public hospitals for the past however many years? Why was that okay whereas getting registered to work, is not?”

Rebeiro qualified as a doctor at Makarere University in Uganda, the oldest medical school in east Africa. He then completed the British licensing exam and worked at London’s Royal National Orthopaedic Hospital.

But he always wanted to specialise in plastic surgery, which he finally managed to do at Wits University after first starting a specialisation in general surgery at the University of Cape Town.

A work ethic ‘second to none’

[quote float= right]I personally know of an Australian doctor who managed to get registered in six weeks”

In a reference letter for Rebeiro to the HPCSA, Professor Elias Ndobe, head of plastic and reconstructive surgery at Wits University, wrote:  “We are in dire need of more specialists in this country in general, and in my institution in particular. I cannot recommend a more worthy candidate for registration.”

Meanwhile, Professor Tim Christofides, described Rebeiro as “a hard and effective worker” in his reference letter.

“His work ethic is second to none and the care he provides to his patients is of a very high standard,” says Christofides, a plastic surgeon at Sunninghill Hospital in Johannesburg who supervised Rebeiro while he was a registrar at Charlotte Maxeke Hospital.

Christofides adds that Rebeiro has valuable medical knowledge that could be passed on to other registrars, and Rebeiro confirms that he has had two job offers from South African universities.

“The HPCSA’s rules need to be uniform and they need to make sense,” says Rebeiro. “There is a lot of unfairness. I personally know of an Australian doctor who managed to get registered in six weeks.”

After a 12-day delay, HPCSA communication manager Priscilla Sekhonyana sent the following response: “Please note that on 18 September 2015, in a meeting with the HPCSA official, the registration process was explained to Dr Rebeiro and on 21 September 2015, Dr Rebeiro acknowledged receipt of the email informing him that the matter will be on the agenda on the next board meeting (date still to be determined) and he will be informed if he should provide any further information.”

In March, Health Minister Aaron Motsoaledi appointed a task team to investigate the HPCSA, saying that he had “received a lot of complaints about governance, efficiency, effectiveness and sometimes even the competency of the management of the HPCSA”.

Task team chairperson Professor Bongani Mayosi confirmed that the task team had recently completed its work, which included public submissions, and handed a report to the Minister.

“I can’t tell you a thing about the report. The Minister is considering it, but my understanding is that there will be an announcement some time this month,” said Mayosi, who heads the University of Cape Town’s Department of Medicine. – Health-e News.

Edited versions of this story were also published by News24 and TimesLive

About the author

Kerry Cullinan

Kerry Cullinan is the Managing Editor at Health-e News Service. Follow her on Twitter @kerrycullinan11


  • This article as touching and true is also very flawed at many levels.
    I too trained with a supernumerary doctor who has since finished and gone back to his country.

    1. To call this “Slavery” is wrong to begin with. These so called supernumerary doctors WERE NOT put in ships and dragged her to labour against their will. They came on their own accord knowing very well where there were going and what it involves.

    2. If i have my facts correct, these supernumeraries know 2 key points PRIOR to arrival and getting registration to train.
    A. They will be UNPAID for the duration of their training.
    B. They will have to return home after completion of training.
    C. Their training WILL NOT be recognised for registration to work in South Africa.

    3. They come and train, which is fine. But when i have to compete with “supernumerary” for the now limited consultant posts, who should suffer? ME, the local South African, or the “slave” supernumerary who came to train here in light of points 1 and 2 above?

    4. Getting permanent residency does not change the facts above. Kerry Cullinan has a very skewed and one angled article here that is seeming making HPCSA the bad one, where as the HPCSA is acting the exact mandate it stipulated when they first registered these supernumeraries.

    5. The likes or Dr Ribiro knew very well he will be unpaid and wont be registered after completion. Why do people like these suddenly change and become “victims” ? Yes, South Africa has a need for specialists, as do all countries elsewhere including Kenia which is African as well. Why dont they want to go back to their countries? Why do they want to take jobs that South Africans can fill?

    Dr Rebiro, the HPCSA is working within its mandate. Let them.
    Kerry Cullinan, reearch both sides of the story.

  • Hi Standive Xolani, thanks for your comments, some of which indicate that you did not understand the article well:
    1. The article does not refer to slavery.
    2. Dr Rebeiro was aware that he would not be paid. However, he was not sponsored by his government so not governed by the supernumerary rules you refer to, including no registration after training. Those are conditions particularly for SADC doctors who can’t specialise in their own countries.
    3. In fact, the HPCSA does not want to register him because it does not recognise his medical degree from Makarere University, not because he is a “supernumerary” (i.e. foreigner). Yet it will happily register doctors from Australia etc to work here. There is inconsistency in the way that the HPCSA applies itself.
    Getting permanent residency changes everything as Dr Rebeiro is allowed to live and work in South Africa.South Africa does not have a lot of unemployed plastic surgeons running around. If there was a glut of plastic surgeons, then your fear of having to compete with a foreigner for a job might hold water but it doesn’t. Dr Rebeiro was going to work for a university and, as indicated by the Wits HOD, there is a huge shortage of plastic surgeons in his institution and Dr Rebeiro would have played a valuable role there – including in training new plastic surgeons.
    I gave the HPCSA an entire 12 days to engage with Dr Rebeiro’s plight but its response was totally inadequate and uncaring – that his case has been referred to a committee that has not even set a date for its first meeting. Even the Minister of Health accepts that the HPCSA is dysfunctional and unable to carry out its mandate properly.

  • I also worked with Dr Robeiro years ago at Somerset Hospital ER. Absolutely brilliant guy. Shame on you HPCSA.